Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Nearly a decade has elapsed since initial publication of a multicentre randomised trial of porfimer sodium photodynamic therapy (psPDT) for the treatment of Barrett's oesophagus (BO) containing high-grade dysplasia (HGD).1 With the addition of endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA) to the therapeutic armamentarium, a seismic shift has now ensued in the treatment landscape of BO-associated mucosal neoplasia. An ever-increasing proportion of patients with BO HGD or T1 oesophageal adenocarcinoma (OAC), opt for endoscopic therapy rather than surgery.2 Durable disease remission is achievable for the majority of patients, with most instances of recurrence being amenable to further endoscopic management and with low rates of salvage oesophagectomy or oesophageal cancer-related mortality.3
Compared with a significant post-treatment stricture rate (>30% for PDT1) and prolonged duration of photosensitivity following psPDT, the relatively lower toxicity profile of newer-generation endoscopic therapies (<10% stricture rate for RFA4) has enabled consideration of whether prophylactic endoscopic therapy may be offered, in lieu of surveillance, to an expanded treatment pool of patients with pathology less advanced than HGD. Indeed, an endoscopic ablation strategy for BO has been envisioned as analogous to the widespread practice of screening colonoscopy and resection of adenomatous polyps for prevention of colorectal cancer.5
Yet at the same time, epidemiological investigation has prompted a recalibration of the risk of BO neoplastic progression. An annual progression rate from non-dysplastic BO to OAC of 0.12% was reported from a …
Competing interests None.
Provenance and peer review Commissioned; externally peer reviewed.